Pericardial effusion and tamponade on ultrasound

A pericardial effusion is an anechoic band between the bright pericardium and the heart. The question that matters at the bedside is whether it is causing tamponade.

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Views

The subxiphoid view looks through the liver at all four chambers — the classic FAST cardiac window. In parasternal long axis, pericardial fluid sits in front of the descending aorta; pleural fluid tracks behind it.

Tamponade signs

Effusion (size matters less than how fast it accumulated).
Right atrial collapse in systole and right ventricular collapse in diastole.
A plethoric IVC that barely changes with breathing.

Tamponade is a clinical diagnosis — hypotension, tachycardia — supported by these findings.

Real scans

Pericardial effusion, subcostal view (animated) — Subcostal (subxiphoid) view with a black layer of pericardial fluid around the heart; the uploader notes impending right atrial/ventricular tamponade. The word FLUIDUM is burned into the image. — **Pericardial effusion, subcostal view (animated).** Subcostal (subxiphoid) view with a black layer of pericardial fluid around the heart; the uploader notes impending right atrial/ventricular tamponade. The word FLUIDUM is burned into the image. Ciernik M · CC BY-SA 4.0 · source

Pericardial effusion with tamponade (apical 4-chamber, animated) — Animated echo of a pericardial effusion causing tamponade; watch the right-sided chambers being compressed during the cardiac cycle. — **Pericardial effusion with tamponade (apical 4-chamber, animated).** Animated echo of a pericardial effusion causing tamponade; watch the right-sided chambers being compressed during the cardiac cycle. Jer5150 · CC BY-SA 3.0 · source

Plethoric IVC in cardiac tamponade (clip). In tamponade the IVC is large and barely changes with breathing (plethoric). Ben Smith · CC BY 4.0 · source

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FAQ

How do you tell pericardial from pleural effusion?

In PLAX, pericardial fluid lies anterior to the descending aorta; pleural fluid extends posterior to it.

Can a large effusion be well tolerated?

Yes, if it accumulated slowly. A small, rapid effusion can cause tamponade.

Related guides

The parasternal long axis viewHow to obtain the parasternal long axis (PLAX) echo view, probe position and orientation, and the structures you should identify — with a live beating-heart simulator.
The IVC on bedside ultrasoundHow to scan the inferior vena cava, what IVC size and respiratory collapse suggest about right atrial pressure, and the big caveats.
The FAST exam, explained by actually doing itHow to perform a FAST exam: RUQ, LUQ, pelvic and subxiphoid views, what a positive scan looks like, common pitfalls — with a live ultrasound simulator you can try.

Educational content for learners; follow local protocols and supervision. Simulated images are generated by Sonoduck’s physics model; real images are credited individually.